Provider Demographics
NPI:1811027857
Name:THE RESIDENCIES AT PLEASANTON
Entity type:Organization
Organization Name:THE RESIDENCIES AT PLEASANTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-352-6658
Mailing Address - Street 1:706 W. 15TH ST.
Mailing Address - Street 2:PO BOX 418
Mailing Address - City:PLEASANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66075
Mailing Address - Country:US
Mailing Address - Phone:913-352-6658
Mailing Address - Fax:
Practice Address - Street 1:706 WEST 15TH STREET
Practice Address - Street 2:#418
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075-0418
Practice Address - Country:US
Practice Address - Phone:913-352-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN054005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility